This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tartarone, A. Articles by Di Renzo, N. Search for Related Content PubMed PubMed Citation Articles by Tartarone, A. Articles by Di Renzo, N. Related Articles Related Article Social Bookmarking                            What's this?

The Predictive Role of HER2 Overexpression in Early Breast Cancer

Centro di Riferimento Oncologico della Basilicata Cancer Center, Rionero in Vulture, Italy

To the Editor: We read with interest the recent article by Moliterni et al¹; in this study, the human epidermal growth factor receptor 2 (HER2) status of 506 breast cancer patients enrolled in a phase III trial comparing cyclophosphamide, methotrexate, and fluorouracil (CMF) alone, with CMF followed by doxorubicin (ADM), was retrospectively analyzed to evaluate its effect on disease-free survival (DFS) and overall survival (OS). The authors concluded that adding ADM to CMF might be beneficial for patients with HER2-positive tumors. We would like to express some observations: first, as recognized also by the authors, the conclusions of the study suffer because of the limited number of HER2-positive cases represented (CMF arm, 50 patients; CMF followed by ADM arm, 45 patients) and because of the biases that are inherent in a retrospective analysis. Second, the influence on survival of subsequent treatments was not investigated; however, considering that, certainly at relapse, the majority of HER2-positive patients on the CMF arm underwent an anthracycline-based regimen, we think that the timing of the anthracycline treatment could also play a role in the survival of these patients. Finally, HER2 overexpression affects approximately 20% of invasive breast cancers, though results vary from 10% to 40% depending on the test used.^2,3 Actually, the use of an adjuvant anthracycline-based regimen is indicated in the high-risk node-negative setting and in the node-positive setting.⁴ How is the percentage of HER2 overexpression (approximately 20% of patients) justifiable with the percentage of patients (approximately 90%) treated with anthracycline in the adjuvant setting? Do other predictive markers exist for response to an anthracycline-based regimen?

Although the use of predictive factors to select the optimal systemic treatment represents the most promising way to improve current outcomes in early breast cancer, there is at present no unquestionable evidence to support the predictive role of any tumor characteristic for response to chemotherapy. In conclusion, the maturing of data from large controlled trials will represent the unique opportunity for defining the role of HER2 overexpression as a predictive marker.

REFERENCES

1. Moliterni A, Menard S, Valagussa P, et al: HER2 overexpression and doxorubicin in adjuvant chemotherapy for respectable breast cancer. J Clin Oncol 21:458–462, 2003[Abstract/Free Full Text]

2. Di Leo A, Dowsett M, Horten B, et al: Current status of HER2 testing. Oncology 63:25–32, 2002 (suppl)

3. Rampaul RS, Pinder SE, Gullick WJ, et al: HER-2 in breast cancer: Methods of detection, clinical significance and future prospects for treatment. Crit Rev Oncol Hematol 43:231–244, 2002[Medline]

4. Goldhirsch A, Glick JH, Gelber R, et al: Meeting highlights: International consensus panel on the treatment of primary breast. J Clin Oncol 19:3817–3827, 2001[Free Full Text]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Article

• In Reply:
  S. Menard, E. Biganzoli, P. Valagussa, P. Boracchi, and A. Moliterni
  JCO 2003 21: 3180 [Full Text]

This article has been cited by other articles:

				Y.-B. Cheung, C. Goh, J. Thumboo, K.-S. Khoo, and J. Wee Variability and Sample Size Requirements of Quality-of-Life Measures: A Randomized Study of Three Major Questionnaires J. Clin. Oncol., August 1, 2005; 23(22): 4936 - 4944. [Abstract] [Full Text] [PDF]

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tartarone, A. Articles by Di Renzo, N. Search for Related Content PubMed PubMed Citation Articles by Tartarone, A. Articles by Di Renzo, N. Related Articles Related Article Social Bookmarking                            What's this?